I often see patients for follow-up and learn they are not taking the medications either I or another health care provider prescribed. Sometimes the reason is obvious, and other times the patient is reluctant to give up the information. Patients have the right to take or not take medication that was prescribed. But, sometimes by not doing so, they are putting their health at risk.
As a doctor, I want my patients to take the medications I prescribed otherwise I would not have done so. In exploring reasons patients often don’t take their medications, many of these are due to misconceptions, lack of clarity or other factors that may be easily corrected. And most often it is not the patients’ fault.
Why do patients do not take their meds?
Cost. Some patients simply cannot afford the cost. The doctor may send the prescription thinking it is the best medication for the patient but then the patients shows up at the pharmacy and learns the price is out of their budget. Many times it is because the medication is not n their insurance companies’ formularies, so they are forced to foot the entire cost themselves. Sometimes the patient is too embarrassed to call their doctor back and admit this, so they go without. But, many alternatives are available in this case. An equivalent medication of the same class may be available that is on the formulary, or maybe a generic of another class may get the job done. The doctors’ office can do a prior-authorization and try to get coverage for the non-formulary medication, although this does not always work. But, no patients should go without needed medication. With the costs of pharmaceuticals these days, these drugs have become cost-prohibitive for most people without any coverage.
Misunderstanding. The patient does not understand why they should be taking a medication and no one wants to take something they don’t need. I often see patients come who don’t know why they are taking certain medications. It is the job of the doctor to ensure the patient understands why a specific treatment is being recommended. If a patient leaves the exam room without knowing this, the doctor has failed in the treatment of that patient.
Myths. We have all seen those lawyer ads on TV that tell people to call them if they took a certain medication. The truth is that all medications have side effects. These side effects need to be balanced with the benefits the medication may offer the patient. And this discussion should happen between the patient and the doctor and a decision made with the knowledge of the risks. Often, a patient will experience a side effect or hear about one and just stop the medication, and the doctor will not know about it until weeks later. It is best to contact the doctor as soon as you decide to stop a medication. There may be other options available. If the medications were so dangerous as the lawyer ads suggest, they would be pulled from the market and no doctor would want to prescribe it.
Time. It seems a simple thing just to swallow a pill. However, many people are so busy that they simply forget. Many medications need to be taken with food or on an empty stomach. Some patients are on multiple medications that cannot be taken at the same time as others. It can result in a very careful scheduling balancing act every day. We need to simply this, such as prescribing once daily medication versus multiple doses when possible.
There are many reasons patients don’t follow our advice and take their medications. As health care providers, we do a great disservice to our patients when we fail to give them the proper education s to why they should be taking a certain medication or what to expect in terms of side effects. We can be prescribing the best therapies in the world for our patients. But, they won’t work unless the patient actually takes them.
Linda Girgis is a family physician who blogs at Dr. Linda.
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